Flexible bronchoscopy (FOB) is frequently used in intensive care units (ICUs) for diagnostic sampling and therapeutic airway management. However, real-world practice patterns, organizational barriers, and perceived unmet needs remain poorly described.

We conducted a cross-sectional international online survey targeting ICU specialists. The questionnaire explored bronchoscopy availability, indications, perceived utility, safety concerns, logistical constraints, and priorities for future improvement. Responses were collected worldwide without a predefined denominator.

A total of 328 ICU clinicians responded, of whom 88% were ICU consultants. Respondents were practicing in 49 countries, including 65% from Europe. Respondents had a median of 17 years since graduation and primarily worked in mixed medical-surgical ICUs with a median of 20 beds. Bronchoscopy was performed mainly by ICU specialists (68%), and 87% reported 24/7 access. However, only 25% reported the existence of a local bronchoscopy protocol. Nearly half of respondents performed FOB almost daily, most commonly for sampling or bronchoalveolar lavage. Reported priorities were highest for immunocompromised patients (median score 8/10) and atelectasis (8/10), whereas community-acquired pneumonia ranked low (3/10). Safety concerns strongly influenced decision-making (8/10), particularly in hypoxemic patients (75%). Laboratory turnaround times varied widely, across centers. Complications were generally rated as low severity.

ICU bronchoscopy is widely accessible and frequently performed, yet protocols remain uncommon and safety concerns represent major barriers, even though rarely occurring. Delays in microbiological results and variability in practice highlight important unmet needs, particularly in immunocompromised populations.